Healthcare Provider Details

I. General information

NPI: 1982120994
Provider Name (Legal Business Name): ALLY HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WINDBROOK DR
PIPERTON TN
38017-5182
US

IV. Provider business mailing address

205 WINDBROOK DR
PIPERTON TN
38017-5182
US

V. Phone/Fax

Practice location:
  • Phone: 901-606-6352
  • Fax:
Mailing address:
  • Phone: 901-606-6352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: DANIEL OKEMBA OKELLO
Title or Position: CEO
Credential: BEHAVIOR ANALYST
Phone: 901-606-6352